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EE WORKSHEET PER EACH, FACILITY <br /> FACILITY , <br />)BA' _ ADDRESS _ ; <br />',AILING ADDRESS 141 <br /> $ (t <br /> Operating Permit Application/Annual Inspection Fee <br /> a. First Tank at Facility P $150. <br /> b. Additional Tanks (N Additional Tanks x $50) z <br />'. State Surcharge (per tank) (Due with Pernk t Application. <br /> on renewal or amendment of operation permit and temporary closure) <br /> ($56 x Total N Tanks) <br /> 1. *Temporary Closure (per tank) Underground Storage Tank in which <br /> storage has ceased but where the owner/operator proposes to <br /> re-use tank within 2 years. <br /> (N ' Temporary closures x $80) (See above 03 to calculate surcharge) <br /> 3• *Permanent Closure (per tank) Underground Storage Tank in which <br />�r <br /> storage has ceased and where the owner/operator has no intent <br /> of re-using tank; <br /> (N Permanent Closures x $90) <br /> 5. P1 an Check Fee $30. ,t <br /> rc � ' <br /> Total Number of Tanks -3 - TaM Fee Due <br /> 4//o --wK <br /> Make all fees payable to San Joaquin Local Health District. Enclose this worksheet <br /> withyour check. <br /> EXAMPLE - Annual Fee for Facility with 4 Tanks <br /> (1 regular, 1 unleaded, 1 supreme. l waste oil) <br /> Ia. Existing Facility b 1st Tank $150 <br /> b. 3 Additional Tanks x $50 150 <br /> 2. State Surcharge. 4 Tanks x $56 224 <br /> Total Number of Tanks 4 Total Fee Due $524 <br /> *both closures will be conditioned. Contact a- Health District Representative. <br /> 2-8.6 <br /> , AA_may A <br />